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Questions and Answers

Difficulty breathing when lying on the spine (back) is referred to as ______.

Orthopnea

The shape of the thorax associated with emphysema is called a ______ chest.

barrel

What is the medical term for chest pain typical of acute coronary syndromes?

Angina

Physical wasting associated with chronic lung disease is known as ______.

cachexia Signup and view all the answers

What is the term for low blood pressure?

Shock Signup and view all the answers

What is the sitting position that emphysema patients often use when they are in trouble?

Tripoding Signup and view all the answers

What is the medical term for a drop in blood pressure on inhalation, often associated with asthma and hyperinflation?

Pulsus paradoxus Signup and view all the answers

What is the term for soft tissue sucking in around the ribs and neck when a patient is in severe distress?

Retractions Signup and view all the answers

What is the term for dizziness associated with a drop in blood pressure?

Syncope Signup and view all the answers

A rapid heart rate may indicate a low blood O2 level and is called ______.

Tachycardia Signup and view all the answers

What is the medical term for the presence of a fever?

Febrile Signup and view all the answers

What is the difference between systolic and diastolic blood pressure?

Pulse pressure Signup and view all the answers

What condition involves a slow heart rate that may result in poor perfusion of tissues?

Bradycardia Signup and view all the answers

What condition is characterized by bluish discoloration of the skin, often associated with hypoxemia?

Cyanosis Signup and view all the answers

What is the term for the situation where the heart rate auscultated in the chest is different than the pulse rate felt in the arm?

Pulse deficit Signup and view all the answers

What condition is characterized by difficulty breathing?

Dyspnea Signup and view all the answers

What condition is characterized by a sensation of suffocation?

Breathlessness Signup and view all the answers

What are musical inspiratory or expiratory sounds called?

Wheezes Signup and view all the answers

What are the inspiratory sounds associated with atelectasis, pneumonia, and fibrosis called?

Crackles Signup and view all the answers

What kind of sound is produced by upper airway obstruction and may indicate a life-threatening condition?

Stridor Signup and view all the answers

What information should be reviewed before entering a patient's room?

The patient's medical record, which includes information about their history of present illness, chief complaint, past medical history, family/environmental history, and systems review. Signup and view all the answers

How should a patient be approached for an interview?

It is best to greet the patient politely, sit at eye level, and identify yourself and your purpose. Be respectful of their privacy and ensure a comfortable interview environment. Signup and view all the answers

When are closed questions most useful during a patient interview?

Closed questions are most useful when seeking specific information or clarification. Signup and view all the answers

What is the Borg scale and how is it used?

The Borg scale is a subjective scale that quantifies the level of dyspnea, allowing patients to rate their shortness of breath from 1 (least) to 10 (worst). Signup and view all the answers

How can you identify the degree of dyspnea a patient feels?

You can identify the level of exertion (activity) at which the patient experiences dyspnea. Signup and view all the answers

What is the difference between dyspnea and breathlessness?

Dyspnea is the sensation of difficulty breathing, while breathlessness refers to the feeling of not getting enough air, often accompanied by anxiety. Signup and view all the answers

Which of the following are possible causes of a dry cough?

Congestive heart failure Signup and view all the answers

Which of the following are possible causes of a loose, productive cough?

Chronic obstructive pulmonary disease Signup and view all the answers

What is the difference between mucus and sputum?

Mucus is normally produced by healthy airways, while sputum is mucus that has been expectorated, meaning it has been coughed up. Signup and view all the answers

What are three characteristics of sputum that should be documented and reported to the healthcare team?

Viscosity Signup and view all the answers

What is the most serious kind of nonpleuritic chest pain?

Angina Signup and view all the answers

How is pleuritic chest pain typically localized?

Pleuritic chest pain usually occurs laterally or posteriorly, often exacerbated by deep inspiration. Signup and view all the answers

What is the difference between nonpleuritic and pleuritic chest pain?

Nonpleuritic chest pain is typically located in the center of the chest with the possibility of radiation, while pleuritic chest pain is more localized to the side or back. Signup and view all the answers

What effect does a significant elevation in temperature (fever) have on metabolic rate, oxygen consumption, carbon dioxide production, and breathing pattern?

A fever increases metabolic rate, oxygen consumption, and carbon dioxide production, leading to an increase in breathing rate and depth to compensate for the increased oxygen demand. Signup and view all the answers

Which two signs are highly suggestive of respiratory infections? (Select all that apply)

Purulent sputum Signup and view all the answers

What does 'CC' stand for in the context of medical history?

CC stands for chief complaint, the main reason for seeking treatment. Signup and view all the answers

What does 'HPI” stand for in the context of medical history?

HPI stands for history of present illness, a detailed description of the patient's current symptoms and their progression. Signup and view all the answers

What are the important areas described in the HPI? (Select all that apply)

Location of pain Signup and view all the answers

What important areas are described in the PMH? (Select all that apply)

Hospitalizations Signup and view all the answers

What are the significant findings associated with a weak, emaciated, and diaphoretic appearance in a patient?

A weak, emaciated, and diaphoretic appearance may indicate general ill health, malnutrition, fever, stress, and acute anxiety. Signup and view all the answers

What is the significance of an anxious appearance in a patient?

An anxious appearance can suggest a severe underlying problem or a high level of anxiety, which may require further investigation and intervention. Signup and view all the answers

What is significant about a patient sitting up and leaning with their arms on a table, known as tripoding?

Tripoding is a typical position used by patients with obstructive lung diseases, such as COPD, who are struggling to breathe and can't lie flat. It helps them access more air and reduce the workload on their respiratory muscles. Signup and view all the answers

What does 'oriented x 4' mean in the context of assessing a patient's sensorium?

Oriented x 4 means the patient is fully oriented and aware of their current circumstances, including time, place, person (themselves), and situation. Signup and view all the answers

What should a respiratory therapist assess first in a patient with a decreased level of consciousness?

A respiratory therapist should initially assess a patient's oxygenation. This involves checking their oxygen saturation levels and ensuring they are receiving adequate airflow. Signup and view all the answers

What is the difference between lethargic and obtunded patients in terms of alertness?

A lethargic patient is easily arousable and responds appropriately once awake. An obtunded patient is difficult to arouse but still retains some level of awareness and responsiveness. Signup and view all the answers

What is the key difference between a stuporous and a comatose patient?

A stuporous patient can be aroused, albeit briefly, and may respond to painful stimuli. A comatose patient is completely unresponsive and lacks awareness of surroundings. Signup and view all the answers

What is the medical term for palpable vibrations felt in the pulse?

Bruits Signup and view all the answers

What is the medical term for the strength of a pulse?

Amplitude Signup and view all the answers

What is the medical term for a decrease in the amplitude of the pulse with inspiration?

Paradoxical pulse Signup and view all the answers

What is the medical term for alternating strong and weak pulses?

Pulse alternans Signup and view all the answers

What is the medical term for normal breathing patterns?

Eupnea Signup and view all the answers

What condition involves an abnormally high respiratory rate?

Tachypnea Signup and view all the answers

What condition involves labored breathing in an upright position?

Platypnea Signup and view all the answers

What condition involves deep breathing?

Hyperpnea Signup and view all the answers

How can you avoid alarming a patient while taking their respiratory rate?

You can count a patient's respiratory rate immediately after taking their pulse, while keeping your fingers on their wrist. This minimizes the patient's awareness of the assessment. Signup and view all the answers

What does a larger (greater than 10 mmHg) decrease in pulse strength during inspiration indicate? What is the medical term for this phenomenon?

A larger decrease in pulse strength during inspiration, greater than 10 mmHg, suggests a significant decrease in blood pressure associated with breathing and is known as Pulsus paradoxus. Signup and view all the answers

Describe a barrel chest and its associated condition.

A barrel chest is characterized by an increased anteroposterior diameter, horizontal slope of the ribs, and associated with emphysema. Signup and view all the answers

Describe Kyphosis and its associated conditions.

Kyphosis is an abnormal, forward curvature of the spine, which can restrict lung function and contribute to restrictive lung disorders. Signup and view all the answers

What is Kyphoscoliosis and its associated condition?

Kyphoscoliosis is a combination of kyphosis and scoliosis, a sideways curvature of the spine, and can lead to severe restriction of lung function due to structural limitations Signup and view all the answers

Describe Pectus carinatum and its associated condition.

Pectus carinatum is characterized by a protrusion or outward bowing of the sternum, or breastbone, and can result in restrictive lung disorders due to an abnormal chest wall structure. Signup and view all the answers

What is Pectus excavatum and its associated condition?

Pectus excavatum is a condition marked by an inward depression or concavity of the sternum, which can restrict lung expansion and contribute to restrictive lung disorders. Signup and view all the answers

Describe Scoliosis and its associated condition.

Scoliosis is a lateral curvature or sideways bending of the spine, which can affect chest wall structure and result in restrictive lung disorders. Signup and view all the answers

What are the differences between vocal and tactile fremitus?

Vocal fremitus is a vibration produced by speech that is felt through the chest wall, while tactile fremitus is a vibration produced by the patient's own breathing that is also felt through the chest wall. Signup and view all the answers

How do fremitus differ in patients diagnosed with emphysema and pneumonia?

Emphysema causes decreased fremitus due to hyperinflation of the lungs, making the vibrations less noticeable. Pneumonia, on the other hand, typically increases fremitus due to consolidation of the lung tissues. Signup and view all the answers

How does subcutaneous emphysema form and what is the feeling of air under the skin called?

Subcutaneous emphysema occurs when air leaks from the lungs into the tissues under the skin. The crackling sensation of air under the skin is called crepitus. Signup and view all the answers

What are the percussion notes associated with emphysema, atelectasis, pleural effusion, pneumothorax, and pneumonia?

Emphysema: increased resonance (hyperresonant). Atelectasis: decreased resonance (dull or flat). Pleural effusion: decreased resonance (dull or flat). Pneumothorax: increased resonance (hyperresonant or tympanic). Pneumonia: decreased resonance (dull or flat). Signup and view all the answers

What are limitations of percussion?

Percussion cannot always detect small or deep abnormalities accurately. It is difficult to accurately determine the location and extent of abnormalities using percussion techniques alone. Signup and view all the answers

What are the mechanisms and causes of coarse, low-pitched crackles and fine, end-inspiratory crackles?

Coarse, low-pitched crackles are typically caused by secretions or fluid being moved by air in the airways. Fine, end-inspiratory crackles occur due to sudden opening of peripheral airways, often associated with restrictive lung conditions. Signup and view all the answers

What are the differences between monophonic and polyphonic wheezes?

Monophonic wheezes are typically heard on inspiration or expiration, indicating a single obstructed airway, while polyphonic wheezes often occur on exhalation and may indicate multiple obstructed airways. Signup and view all the answers

How do you assess capillary refill time? What is considered normal?

Capillary refill time is assessed by pressing briefly on a fingernail until it blanches, then observing how long it takes for the color to return. A normal capillary refill time is less than 3 seconds. Signup and view all the answers

Why is it important to check for edema in the feet and legs when assessing heart failure patients?

Edema in the feet and legs is common in patients with heart failure because fluid tends to accumulate in these areas due to gravity. Signup and view all the answers

What is the specific cause of cyanosis?

Cyanosis is caused by deoxygenation of hemoglobin, the protein in red blood cells that carries oxygen. Signup and view all the answers

What is peripheral cyanosis, and what is the main cause?

Peripheral cyanosis is a bluish discoloration of the extremities, often occurring due to poor circulation in the peripheral blood vessels. Signup and view all the answers

Study Notes

Definitions

Orthopnea: Difficulty breathing when lying on the back.
Barrel chest: Thorax shape associated with emphysema.
Angina: Chest pain, typical of acute coronary syndromes.
Cachexia: Physical wasting linked to chronic lung disease.
Shock: Low blood pressure.
Tripoding: Sitting position used by emphysema patients in trouble.
Pulsus paradoxus: Drop in blood pressure during inhalation (associated with asthma or hyperinflation).
Retractions: Tissue sucking in around ribs and neck during severe distress.
Syncope: Dizziness linked to a drop in blood pressure.
Tachycardia: Rapid heart rate, possibly indicating low blood oxygen levels.
Febrile: Presence of a fever.
Pulse pressure: Difference between systolic and diastolic blood pressure.
Bradycardia: Slow heart rate, potentially leading to poor tissue perfusion.
Cyanosis: Bluish discoloration of skin, often associated with low blood oxygen levels.
Pulse deficit: Discrepancy between the heart rate felt in the chest and the pulse felt in the arm.
Dyspnea: Difficulty breathing.
Breathlessness: Sensation of suffocation.

Lung Sound Definitions

Wheeze: Musical inspiratory or expiratory sounds.
Crackles: Inspirations sounds associated with atelectasis, pneumonia, or fibrosis.
Stridor: Upper airway sound, possibly indicating a life-threatening obstruction.

Patient Interview Q&A

Pre-room information gathering: Review patient's medical record, chief complaint, past medical history, family/environmental history, and review of systems (ROS).
Interview start techniques: Maintain appropriate space to ensure eye contact, prioritize privacy (especially in non-private rooms), and introduce oneself and clarify purpose to the patient.
Ideal interview approach: "Good morning [patient name]", sit at bedside, keep clipboard on lap, ask open-ended questions like "Any needs right now?", "Ill be back in an hour", "What are you coughing up?" or "How's your breathing today?".
Closed-ended questions: Useful for clarifying information. (e.g., "How long did the pain last?" or "How much did you cough up?")
Symptoms of CP disease: Borg scale can quantify dyspnea level (subjective symptom). 1 - least to 10 - worst. Helpful in comparison for therapy responses.

Signs and Symptoms of CP Disease (Q&A - Continued)

Identifying dyspnea degree: Assess the exertion level associated with dyspnea.
Dyspnea vs. breathlessness: Dyspnea is the sensation of difficulty breathing, breathlessness is the feeling of not getting enough air.
Possible causes of coughs: Dry coughs can relate to restrictive conditions (CHF, fibrosis). Loose/productive coughs might mean inflammation (asthma, COPD), viral infections, or acute conditions.
Mucus vs. sputum: Mucus is normal airway production; sputum is increased mucus that is expectorated.
Documentation of sputum characteristics: Important for health care teams to document sputum color, viscosity, and quantity.
Serious non-pneumothorax chest pain: Angina.
Pleuritic vs. non-pleuritic chest pain: Pleuritic pain is usually located laterally or posteriorly, and it worsens with inspiration.

Medical History (Continued)

CC and HPI: CC stands for chief complaint (reason for treatment); HPI stands for history of present illness.
Important HPI areas: Onset, frequency, symptom duration, localization, quality, aggravating/alleviating factors, and associated manifestations.
PMH: Past medical history
Vital information: Bruits (palpable vibrations in pulse), amplitude (strength of pulse), paradoxical pulse (drop in amplitude with inspiration), pulse alternans (alternating strong/weak pulses), eupnea (normal breathing patterns), tachypnea (abnormally high respiratory rate), platypnea (labored breathing when upright), hyperpnea (deep breathing), and bradypnea (abnormally low respiratory rate).
Lethargic vs. obtunded: Lethargic patients are easily arousable and respond appropriately. Obtunded patients are difficult to arouse but respond appropriately once aroused.
Stuporous vs. comatose: Stuporous patients do not fully wake up but may respond to stimuli. Comatose patients are unconscious.

Examining the Chest and Lungs (Inspection)

Abnormal chest shapes:
- Barrel chest: Increased anteroposterior (AP) diameter, horizontal slope of ribs, related to obstructive conditions (e.g., emphysema).
- Kyphosis: Abnormal AP curvature of the spine.
- Kyphoscoliosis: Combination of kyphosis and scoliosis, relates to restrictive conditions.
- Pectus carinatum/excavatum: Abnormal sternum protrusion/depression.
- Scoliosis: Abnormal lateral curvature of the spine.
Pulse strength decrease during inspiration: Pulsus paradoxus (>10 mm Hg decrease). This is more often associated with acute obstructive pulmonary disease(e.g., asthma).
Subcutaneous emphysema: Leaked air under skin tissue, characterized by crepitus.
Percussion notes: Conditions determine the sound heard during percussion.

Examining the Chest and Lungs (Inspection) - Continued

Emphysema: Increased or hyperresonant percussion note.
Atelectasis: Decreased (dull) percussion note.
Pleural effusion: Decreased (dull) percussion note.
Pneumothorax: Increased resonance (hyperresonant or tympanic)
Pneumonia: Decreased (dull) percussion note.
Limitations of percussion: Inability to detect small, deeply seated abnormalities.
Crackle types: Coarse (low-pitched), fine, end-inspiratory (caused by secretions or sudden opening of peripheral airways).
Wheeze types: Monophonic (single obstruction) vs. polyphonic (multiple obstructions)

Other Important Concepts

Capillary refill time: Assessing blood circulation by pressing briefly on a fingernail. Normal time is less than 3 seconds.
Peripheral cyanosis: Bluish discoloration of extremities, often due to poor circulation.
Deoxygenation of hemoglobin: Causes cyanosis.

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